Already a cleverbridge affiliate?

If you are not a registered affiliate on the cleverbridge platform yet, please fill out the form below.

Address information

Company:

Salutation:

*First name:

*Last name:

*Street address:

Additional address information:

*City:

*State/Province:

*Zip/Postal code:

*Country:

Phone:

Fax:

*Email:

*Confirm email:

*Affiliate website:

Your account information

Please choose between the following options how you wish to receive your payments from us.

*Currency:

*Payment type:

Payment via PayPal

We will transfer the payment to your PayPal account. Please fill in your PayPal email address into the following field.

*Your PayPal email address:

Payment via ACH transfer

To allow us to do a regular ACH credit transfer to you, please provide us with your account details below:

*Bank name:

*Account number:

*Routing transit number:

Your affiliate account

Please choose a username and password for your new affiliate account. The password must be at least seven characters long and should contain at least one number, one uppercase letter, one lowercase letter and one special character.